Yajima Shugo, Nakanishi Yasukazu, Matsumoto Shunya, Okubo Naoya, Tanabe Kenji, Kataoka Madoka, Masuda Hitoshi
Department of Urology, National Cancer Center Hospital East, Chiba, Japan.
Curr Urol. 2025 Jan;19(1):64-69. doi: 10.1097/CU9.0000000000000177. Epub 2023 Jan 30.
This study aimed to evaluate the impact of the clock drawing test (CDT) on postoperative delirium and compare the abilities of the mini-cognitive (Mini-Cog) test and the CDT for predicting postoperative delirium after major urological cancer surgery.
In this single-center retrospective observational study, we collected the medical records of patients who underwent major urologic cancer surgery and preoperative cognitive screening based on the Mini-Cog test consisting of the CDT and the 3-word recall task at our department in 2020-2021 (n = 387). Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for postoperative delirium. We also compared the ability of the CDT alone and the Mini-Cog test consisting of the CDT and 3-word recall task to predict postoperative delirium.
A total of 117 patients (30%) had abnormal CDT results. Postoperative delirium occurred in 29 patients (7%). On multivariate analysis, American Society of Anesthesiologists physical status ≥3 (odds ratio [OR], 5.0; = 0.01), abnormal CDT (OR, 4.8; < 0.001), preoperative benzodiazepine use (OR, 4.9; < 0.001), and operative time ≥237 minutes (OR, 3.0; = 0.01) were independent risk factors for postoperative delirium. The area under the curve for predicting postoperative delirium was 0.709 for CDT alone and 0.743 for the Mini-Cog test. No significant intergroup difference was observed ( = 0.43).
The CDT served as a formal but simple tool with adequate predictive power to identify the risk of postoperative delirium among patients undergoing major urological cancer surgery. Effective screening using the CDT might help provide optimal urological care for older patients.
本研究旨在评估画钟试验（CDT）对术后谵妄的影响，并比较简易认知（Mini-Cog）测试和CDT预测泌尿外科癌症大手术后术后谵妄的能力。
在这项单中心回顾性观察研究中，我们收集了2020年至2021年在我科接受泌尿外科癌症大手术且基于由CDT和3词回忆任务组成的Mini-Cog测试进行术前认知筛查的患者的病历（n = 387）。采用单因素和多因素逻辑回归分析来确定术后谵妄的临床危险因素。我们还比较了单独的CDT以及由CDT和3词回忆任务组成的Mini-Cog测试预测术后谵妄的能力。
共有117例患者（30%）CDT结果异常。29例患者（7%）发生了术后谵妄。多因素分析显示，美国麻醉医师协会身体状况≥3（比值比[OR]，5.0；P = 0.01）、CDT异常（OR，4.8；P < 0.001）、术前使用苯二氮䓬类药物（OR，4.9；P < 0.001）以及手术时间≥237分钟（OR，3.0；P = 0.01）是术后谵妄的独立危险因素。单独CDT预测术后谵妄的曲线下面积为0.709，Mini-Cog测试为0.743。未观察到显著的组间差异（P = 0.43）。
CDT是一种正式但简单的工具，具有足够的预测能力来识别接受泌尿外科癌症大手术患者的术后谵妄风险。使用CDT进行有效筛查可能有助于为老年患者提供最佳的泌尿外科护理。
